This case concerned a complaint made to the Health Care Complaints Commission (HCCC) of New South Wales about Dr Irfan Noor (Dr Noor), a Stage 2 trainee member of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).
The Tribunal found Dr Noor guilty of professional misconduct and ordered that the Australian Health Practitioner Regulation Agency (AHPRA) record that Dr Noor's registration would have been cancelled had not he voluntarily cancelled it.
Dr Noor graduated from the University of Health Sciences in Lahore, Pakistan, in 2005. Dr Noor completed a Master of Public Health at UNSW in 2009 and later obtained full registration as a medical practitioners in Australia in March 2015. By July 2017, Dr Noor had Stage 2 trainee membership of the RANZCP and was employed as a Psychiatric Registrar at a public teaching hospital in Sydney (the Hospital).
On 10 July 2017, while at a public park, Dr Noor met Person A. Over the period between 10 July 2017 and 4 August 2017, Dr Noor and Person A met several times and exchanged texts. On 4 August 2017 Dr Noor was the Duty Medical Officer (DMO) and at the conclusion of his shift at 5:30pm was the only doctor on duty at the Hospital and present on the Hospital grounds. This is significant, because Dr Noor had previously arranged for Person A to visit him on 4 August 2017 at his Hospital provided accommodation, despite the fact that he was the DMO. Person A arrived at the flat around 8:00pm on 4 August 2017 and remained there with Dr Noor until around 10:15pm.
While Dr Noor was waiting for Person A to arrive following the conclusion of his shift at 5:30pm, Patient A, an inpatient suffering from schizophrenia and substance abuse who was housed in a psychiatric unit (the Unit), returned to the Hospital from 'shop leave' two hours late. Patient A returned around 7:30pm with a blood alcohol consumption (BAC) of 0.1% and informed the nurses on duty that he had an empty ibuprofen plus codeine sheet (which once contained 15 tablets) and that he had taken all the tablets. The nurses on duty were particularly concerned because the patient was on Antabuse, which had been prescribed to discourage the patient from consuming alcohol.
RN Frakes telephoned Dr Noor at around 7:40pm (the First Call), with the expectation that Dr Noor would return to the Unit and assess Patient A. Dr Noor was aware that Patient A was on Antabuse and questioned RN Frakes about whether Patient A had in fact taken all 15 tablets. RN Frakes informed Dr Noor that Patient A's observation were 'between the flags' and he was walking and socialising with other patients. Dr Noor informed RN Frakes that Patient A would be alright and to let him sleep and sober up. Dr Noor claimed that he discussed a management plan with the nurse and reassured her about the effects of Antabuse.
RN Frakes called Dr Noor again (the Second Call) and confirmed that Patient A had in fact taken Anntabuse that morning. Dr Noor told RN Frakes to let him know if Patient A began feeling nauseous and that she was fine to administer Patient A's evening medication. Following the Second Call, Patient A expressed concern about having Antabuse in his system and asked to see a doctor. RN Liu then made another telephone call to Dr Noor (the Third Call) between 8:00pm to 8:30pm. When RN Liu told Dr Noor Patient A had asked to see him, Dr Noor refused to attend the patient and said he knew him well and did not need to see him.
Before the end of her shift at 9:00pm, RN Frakes decided not to give Patient A his nightly dose of Quetiapine, on the basis that he should sober up. The Unit notes for the remainder of the evening of 4 August 2017 showed that the night staff did not give Patient A his Quetiapine either.
Dr Noor did not attend the Unit to review Patient A at any point during the night.
The HCCC applied for disciplinary findings and order with respect to Dr Noor, pleading three complaints in support of its application.
Complaint One, alleged that Dr Noor was guilty of unsatisfactory professional conduct within the meaning of s 139B of the National Law. It was alleged in paragraph 1 of Complaint One that Dr Noor acted improperly and unethically in that he:
- bought alcohol and stored it at the [hospital provided] accommodation, contrary to Ministry of Health guidelines;
- engaged in sexual activity with Person A, including watching pornography; and
- invited Person A to return to the accommodation that night to sleep there.
Paragraph 2 of Complaint One concerned the First Call and alleged that Dr Noor displayed a significant lack of judgment and exercised a significant lack of care in that he:
- declined to attend to examine Patient A and conduct a face-to-face clinical interview and physical examination;
- made an inadequate assessment of Patient A's mental state;
- made an inadequate assessment of Patient A's clinical state including no assessment of opioid intoxication;
- made an adequate risk assessment of Patient A;
- did not make a temporary management plan for Patient A;
- inappropriately authorised Patient A to be given his prescribed nightly dose of Quetiapine without first conducting a physical review of Patient A;
- did not provide reasonable support and reassurance to nursing staff; and
- prioritised his involvement in sexual activity that was occurring simultaneously…with Person A at the on-call DMO accommodation over Patient A's care and his clinical leadership role of the nursing staff on duty in the Hospital.
Paragraph 3 of Complaint One set out particulars in relation to the Third Call and Dr Noor's and also alleged that Dr Noor's displayed a significant lack of judgment and exercised a significant lack of care on 4 august 2017. Significantly, paragraph 4 of Complaint One alleged that Dr Noor deliberately misled the Medical Council of NSW in September 2017 at a s 150 hearing, when Dr Noor told the Council he declined to review Patient A on 4 August 2017 because Patient A had previously been AWOL and taken substances, failing to disclose that his decision not to attend Patient A was influenced by a desire to remain in the flat with Person A.
Complaint Two alleged that Dr Noor was guilty of professional misconduct under s 139E of the National law in that he:
- engaged in unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration; or
- engaged in more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify the suspension or cancellation of the practitioner's registration.
Complaint Three then alleged that Complaint One and its particulars both individually and cumulatively justified a finding of professional misconduct, or that, in the alternative, particulars 4, 2(h) or 3(g) each individually justified a finding of professional misconduct.
The Tribunal found that particular 1a of Complaint One was not made out. The Tribunal did however find that it was undisputed that Dr Noor had engaged in sexual activity with Person A and that particular 1b of Complaint One was established. Complaint 1c was also made out.
During the hearing, the Tribunal heard evidence was from three Psychiatrists, Dr Smith, Dr Vandaleur and Dr Patfield, who were all highly critical of Dr Noor's failure to assess Patient A on the evening of 4 August 2017. The Tribunal noted that as inpatient in a Unit in the Hospital, Patient A 'did not have the ability to seek to gain access to medical assistance from any source other than the Hospital' and that '[w]hen the practitioner, as the DMO, failed to fulfil his duty, the patient did not have recourse to any other medical advice and was reliant upon the nursing staff..'
The Tribunal also found particulars 2a to 2g of Complaint One and particulars 3a to 3f of Complaint One to have been established. Dr Noor's conduct in relation to each of those sub-particulars was considered by the Tribunal to constitute unsatisfactory conduct.
The Tribunal determined that 'cumulatively, the conduct described in particulars 1b and 1c, 2a to 2h inclusive, particulars 3a to 3g inclusive and particular 4 amount to professional misconduct on the part of the practitioner pursuant to s 139E(b) of the National Law.' The Tribunal concluded that considered together, Dr Noor's conduct was 'sufficiently serious to justify the suspension or cancellation of [his] registration.' In particular, in reaching this finding, the Tribunal noted Dr Noor's act of misleading the Medical Council during his hearings in 2017 and 2018, which the Tribunal considered to be particularly egregious.
In deciding upon appropriate orders in this matter, the Tribunal noted that Dr Noor had given significant evidence about the effect the events on and in the wake of 4 August 2017 had had on him. The Tribunal took into account the fact that Dr Noor had previously had a complaint made in 2016 about inappropriate sexual conduct towards a female co-worker which he had blamed on marital problems and the fact that he continued to blame others for his conduct now. The Tribunal also had regard to the fact Dr Noor deliberately failed to disclose, or deliberately misled, the Medical Council in two separate hearings relating to the events of 4 August 2017.
The Tribunal considered that 'the practitioner has a considerable amount of work to do to address those aspects of his personality, his ways of thinking and his personal circumstances which played a part in the events of the evening of 4 August 2017.' The Tribunal was unable to assess how long it would be before Dr Noor would be fit for practise and therefore did not specify a period within which Dr Noor may not be able to apply to be re-registered.
Finally, the Tribunal noted that Dr Noor had already voluntarily cancelled his registration and in view of this fact ordered that:
- The Australian Health Practitioner Regulation Agency is required to record the fact that, had the practitioner been registered, the Civil and Administrative Tribunal of NSW would have cancelled the practitioner's registration on account of professional misconduct.